MedNet Jordan is one of the leading managed care service organizations that caters to healthcare needs. We are currently seeking to hire an Officer – Claims (on Hybrid working modules basis) with the following tasks and responsibilities:
Your Job
Medical Claims Processing
- Applying Claims Department Policy, Procedures and quality measures for processing claims.
- Processing Claims efficiently & accurately, according to FIFO (First In First Out) of providers network claims along with international claims through network providers.
- Process the EPD (Early Payment Discount) batches according to priorities as per assignment from Claims Team Leader.
- Entering data accurately in order to provide accurate records to the company and Participated Insurance Companies (PICs).
- Work in high speed and efficiency to achieve monthly targets.
Medical Claims Evaluation:
· Authorization for in and out-hospital cases in respect of medical necessity and appropriateness.
· Evaluation & approval of outpatient & Inpatient claims need authorization in respect to the medical necessity and appropriateness and check them in the system to ensure high quality and correct services.
· Chronic soap evaluation, issue, checking, sign & stamp.
Quality & Audit of Claims Processed
- Conduct Medical Audit and review sample of Processed Claims – sample defined as per confidence level target set on a yearly basis - against scope of coverage and provider contracts as set in Claims Best Practice Manual.
- Checking batch list for printed out bordereau when required ahead of bordereau issuance.
Your Profile
Bachelor degree in Nursing, pharmacy or physician.
1-3 years of experience in medical field.
Experience in insurance industry or TPA is a plus
Computer literacy ( MS Office, Excel, PowerPoint)
Knowledge related to medical terminology
Good Command in English language.
Industry knowledge related to local health services system is a plus.
Team Player
Eager to learn and seek for knowledge.
Good interpersonal and negotiation skills
Excellent written and verbal communication skills.
Analytical Thinking